Impressions

Members of the Society and guests. In 1951 when Mr Jackman was President of this Society, I as one of his dressers, was permitted to attend my first 'MedChi' meeting. I was overawed. The 'Med-Chi' was, after all, the premier postgraduate society of the City and far beyond. I remember how fascinated I was to observe the proceedings and to register the elegant eminence of the members. Little did I consider then that I might emulate 'Jacko' and for this honour I am grateful to you all. The title of my address is?'Impressions' and I hope to

Secondly and more bemusing; Marcel Proust in his 'A la recherche du temps perdu'; his peon of delight from ies petites madeleines'?those squat plump little cakes dipped into herb tea, so rekindled memories of his Aunt Leonie and his beloved village of Combray and enabled him to write with such artistry, brilliant psychological insight and painting of his characters. For Proust one needs time and concentration, but truly, it is worth it. (Proust. Remembrance of Things Past. Vol 1 p48. Kilmartin translation.) For him the past still existed.
To begin with, some impressions of my family and forebears to include many alive during my lifetime. They were mostly very ordinary people. We possessed our share of skeletons but none will be consciously revealed.
My maternal great grandfather Robert Moon 1846-1902, lived in Lilymead Avenue, Knowle (Plate 1). He owned and ran a tin printing factory near Temple Church and died of probably gastric cancer. His large funeral on 9th June 1902 was reported in the local press and because he was a Sunday School Superintendent at Wycliffe Congregational Church, some 300 scholars followed the cortege to Arnos Vale Cemetery and sang his favourite hymns at the graveside. On 20th May 1866 he had married Sarah Bruton at St Simon's Church Baptist Mills who survived him with five children, the penultimate was my grandfather Robert Henry Moon b.28.4 offspring from Thomas and Mary Coates, of whom Emily, Harriet, Richard and Will are the important 'white sheep' for my story. The mother Mary, had died young and Emily the eldest girl, not only brought up the others but trained as a teacher.
The wedding reception of my grandparents took place at the Coates home in Oxford Street Totterdown. They very soon moved, together with a sizeable population exodus from South Bristol to the newly built northern suburb of Bishopston. Their rented house was 47, Theresa Avenue and there, on 26.2.1897, my father, Charles Reginald was born after two previous still births. His mother had suffered damage from rheumatic fever and my father's survival was? according to Aunt Emily, who was present?fortuitous. Left to himself he happened to breathe! Not surprisingly he developed into a somewhat cossetted boy, adored by his sickly but in other ways sparkling mother. She was known to all as 'Polly'. She was vivacious, very pretty and possessed a lovely singing voice; which gift was passed on.
My father, after early private education, went to Sefton Park School where he made his mark as an actor. His prime role was the Mad Hatter in 'Alice in Wonderland'. He was very good at sport, fair at work, and well thrashed: keeping pigeons was his hobby. His formal education was completed at the newly opened Fairfield School where he was marched from Sefton in the first group of pupils (c 1908). Archie Leach (Carey Grant) attended the same establishment somewhat later.
Years after, in the 1960's, my father walked around Sefton Park School and encountered the names of his many friends recorded on the school memorial . He remembered every one of them and their foibles.
Reg, as he was always known, was extremely fond of the Coates side of his family?they were the more artistic?and at a family wedding in 1907 when his favourite and most supportive Aunt Emily married an elderly widower from Gloucester?Charles Dancey?an important family gathering is recorded (Plate 4). The lads include my father and his two cousins, Fred and Ernie Coates?children of Will and Alice?both of whom subsequently achieved great success as men of business. Two uncles are present and both played significant roles in the story. Richard (Dick) a tall upstanding and delightful man, was the spiritual and financial supporter to his ailing sister Polly and my grandfather. He  Alleviation did arrive, for in 1935 Julie was born and in 1937 we were briefly reunited with the remarkable Aunt Emily Dancey who came over from Capetown for a holiday. I now return to the wedding of 1928 to highlight the Moon family (Plate 7). My grandpa, Robert Henry, lost his left arm in an accident at the family factory because the normal press operator had gone to the war (1914). The limb was amputated through mid arm at the General Hospital and overnight and for decades to come that event constituted an economic near disaster. My grandmother?Lizzie?to whom I was very attached, developed progressive dysphagia in 1947 and months later was taken into the Homeopathic Hospital. Although assessed by R V Cooke she died a few days later. In due course as a medical student, I listened to Ronald Belsey harangue medical neglect in many cases of oesophageal cancer where the patient is late referred when the doctor's medicine cannot be swallowed. It so happened to Lizzie. Many years later when on the staff of the same hospital, I sought the notes for both Mary and Lizzie. Both had been torn out of the nicely bound record book! I was not surprised.
There were happy years in the late 30's and we lived in a cosy house, 1 Dongola Road. I resided mostly in the upper branches of my favourite apple tree and started at Sefton Park School. My father often took me to the County Ground and before the age of 10, I had seen Wally Hammond score several perfect centuries. My grandfather Ernest, had in 1929, remarried. Ethel Humfrys Maddox was the daughter of a former Bristol Corn Merchant and a Sunday School teacher at Horfield Baptist. She was an interesting and impressive lady. To me she was my paternal grandmother. I knew no other. Over many years she was very good to me. The couple moved to The Firs, Breaches Road, Easton-in-Gordano?
which became for me a haven of delight (Plate 8). Ernest died there in 1955, aged 88?Ethel survived him by nearly twenty years. Ernest had worked as a Cartographer in Ordnance Survey, but since 1929, his life was that of contented, affluent retirement. He was a kindly, gentle man of strong nonconformist religious convictions. Reported to have been an impressive preacher, his handwriting was truly admirable and his standard grace at table I have adopted as my own.
An error of judgement coincident with September 1939 made us move from Dongola to 8 Berkeley Road, Bishopston. Other mistakes followed and the '39-45' war was punctuated by intermittent tragedies so that the halcyon days of the 1930's were sadly long gone. By September 1940,1 was fortunate to enter Cotham School and I left in July 1948. Despite the 'Blitz' and other vicissitudes of the Second World War, my impression was of an excellent grammar school education which extended into academic sporting and cultural pursuits. It is a sadness to me that the state grammar school has gone. During the war I acquired two more sisters; in 1944 and 1946. At the time it was a shock, and to observe my father watching me play for the first XV accompanied by a baby in a pram required some personal and peer adjustment. They grew up into charming, thoughtful, talented and admirable girls and both have sustained and overcome great personal sorrows.
My grandfather Ernest was a moderate respiratory cripple (dating from the 1918 influenza epidemic) for the latter years of his life and died at The Firs on Easter Sunday 1.4.55. This house is now occupied by a delightful and considerate family who allowed me to look over the house in September 1988. It has been most tastefully modernised and bears a happy welcoming atmosphere.
My father Reg, was a supportive and inspiring father. In some ways his example was of the negative variety, and I regarded his life as one of unrealised and unfulfilled talent. His interest in literature and his gifts for oratory and singing were considerable but he was never allowed to enter his chosen career of the stage. Properly directed, he could have succeeded as a teacher of English and Drama. He possessed a fine ear for poetry, a perceptive interpretation of literature and left behind many notebooks of 'gems' abstracted from his reading. He was a very capable amateur operatic actor and his finest roles were Dr Engel in the 'Student Prince' and Dvorak in 'Summer Song' (Plate 9). Dating from the 'Trenches', too many cigarettes induced hypertension and chronic obstructive airways disease. In April 1971 he died in Budd Ward BRI from a massive stroke. It is appropriate at this time to state that my mother is an exceptional lady and her many qualities are beyond praise.
I have been blessed with a very happy marriage and four children, but the story of that is too long and exciting to tell. There are however two events of momentous importance.  1914-1918. Reg served in the Great War from 1915-1918 (Plate 11). My interest, which at times amounts to an obsession, was kindled by my boyhood 'chats', but largely his residual equipment: a tin hat, spurs, medals, puttees and above all two scruffy magazines; 'Fragments from France' by Capt. Bruce Bairnsfather. I knew all the cartoons. One classic example is "keep yer ead still or I'll have yer blasted ear off". Unsophisticated humour; clean, direct and so evocative (Plate 12).
Since 1960, my interest has surged and I have read many books as well as visiting the Somme battlefields. One poignant aspect of my story refers to Will Coates my father's uncle. When Reg enlisted he went to the Colston Hall. At his mother's pleading, Will went with him. At the door stood a Warrant Officer who was directing lads to different recruiting tables. Will placed two golden sovereigns in his hand and whispered?"put him in the Artillery his mother's got a bad heart". So, a perceptive uncle and a bribe enlisted Reg into the Royal Garrison Artillery. That  In 1916, both men were infantrymen with the Devons and I have it on sound authority that both went 'over the top' that morning; Bill was wounded in the leg and Percy carried him back from 'No Mans Land'. The finest Remembrance Day homily I have ever heard came from Percy. A casual, but deeply moving chat?especially for the boys. After all he had been there! That particular service was doubly rewarding. The motet performed by the school choir and orchestra was by a composer who until then was unknown to me: Claudio Monteverdi. The boys sang 'Beatus Vir' and it was and is a beautiful revelation.
The third battle of Ypres?'Wipers' to the soldiers?is generally regarded as exceeding the Somme in its horror. It is often known as just?Passchendaele?which is a village east of Ypres. John Masters (Fourteen-Eighteen) 1965 describes it as 'courage and sacrifice beyond understanding'. Such was the separation between the front line soldiers and their Generals that the whole event is rendered even more incomprehensible. In 1917, Sir Lancelot Kiggell who was Haig's Chief of Staff was driven forwards to the front. He is reported to have broken down into tears, "Good God" he muttered, "did we really send men to fight in that". One could echo this impression for the whole war (Plate 14).
In 1918 Vastly out numbered, Gough fought one of the greatest retreats in history and was summarily sacked in April 1918 for so doing. My father's unit was destroyed but he had escaped through being at home on compassionate leave because of his mother's dire cardiac illness. He returned to a different unit.
Gough was shabbily dealt with by Lloyd George and others and it was not until 1930 when Lord Birkenhead (F E Smith) published his book Turning Points in History' and devoted a whole chapter to Gough's 5th Army triumph against enormous odds that amends began. Gough died in March 1963 and his obituary in the Daily Telegraph was warm and complimentary to his personal qualities and dignity through years of adversity. His book, The Fifth Army' was bought by my father and is now my treasured possession. Incidentally the Fifth or 'Red Fox' Army is commemorated (1939!) without and within the entrance hall of St Mary's Hospital, Paddington.
Whenever I pass the bronze statue of Earl Haig on the close at Clifton College, I mentally cringe. I wish it was not there. The soldiers of 1914-18 deserved better from their Generals and my excuses for being interested in this period are that it was momentous and one cannot fail to be amazed at the enormous courage of the soldiers. The fact that it was an unbelievable waste of life and hope, cries out from the well kept and beautifully simple graveyards and memorials which remain.
The third element of impressions is the briefest and relates to my research. Brian Nicholas Brooke sometime Professor of Surgery at St George's Hospital, London and Reader in Surgery at the QEH, Birmingham in the early 1960's, is an artist of note; a man of wide culture, a surgical thinker of the highest quality and to crown it all, a sparkling personality. He invented the spout ileostomy as we know it today. He guided the surgical registrars in research and set me towards a project on studying lymph nodes draining colonic carcinoma.
To further this, 1 returned to Bristol and consulted my friend and colleague Dennis Osmond; later to become Professor of Anatomy at McGill Univesity, Montreal. Dennis recommended that I tried lymph node impressions or imprints.
The impression technique on the freshly bisected excised lymph node involves touching the cut surface on to a dry slide in order to make a representative smear of the constituent cells. (Long Fox Lecture) 1973. The air dried smear is fixed in methanol and stained by May-Grunwald Giemsa or just Giemsa alone.
Imprints are one element of tissue cytology, and together with scrape-smears and fine needle aspiration biopsy have dominated and complemented my surgical pursuits without relaxation or respite since 1964. It is indispensable in surgical practice especially for breasts, goitres, salivary gland lesions, lymph nodes, soft tissue tumours and other sites. For me, it all began with Bryan Brooke and by a kind suggestion from Dennis Osmond.

Plate 13
An infantry trench, the Somme, 1st July 1916; preparing to go 'over the top'! Note the youth and modest size of soldiers in the foreground. By 1883, and soon after, Impressionists were becoming accepted and their pictures sought after, especially for Monet. He moved, with his mistress Agnes and entourage, to the village of Giverny. Initially he lived in a rented house but in 1886 moved to his eventually renowned residence, 'Le Maison du Pressoir'. By now he was famous. He painted, Poplars on the Epte (1891) and he painted a set scene at different seasons and in different lights. Some critics have criticised his abstract style at that time. It is a matter of taste.
His garden at Giverny was developed and water lilies were planted in the pond. The bridge was built and is immortalised on many canvases. The water lilies were the object of great (Plates 17 and 18.) Footnote A significant component of this address was its visual content. A large number of both colour and black and white transparencies were projected. Some of the latter are shown here.